BILLING NEWS

UnitedHealthcare NPI Enhancements for Government and Other Lines of Business

The following enhancements apply to UnitedHealthcare Government and other lines of business. You may begin to see these changes starting with 835s and payments received from UnitedHealthcare after June 19, 2010.

National Provider Identifier

UHC will implement the following changes for Government and other lines of business which will improve the consistency between the National Provider Identifier (NPI) received on a claim and the NPI returned on the 835I:

The proprietary provider ID will no longer be reported on the 835 in REF*G2 of Loop 1000B.

For electronic submitted claims:

  • We will return the Pay-To NPI number supplied in the ANSI X12 837 as the Payee NPI in the 835. If no Pay-To NPI is submitted, the Billing NPI will be returned in the Payee NPI in the 835, Payee loop 1000B, NM104 with XX (NPI) qualifier code in NM103.
  • We will return the Rendering NPI number supplied in the ANSI X12 837 as the Service Provider NPI in the 835.

For paper submitted professional claims:

  • We will return the Billing NPI number supplied in Box 33a of the revised 1500 claim form as the Payee NPI in the 835.
  • We will return the Rendering NPI number supplied in the revised 1500 claim form as the Service Provider NPI in the 835.

For paper submitted institutional claims:

  • We will return the Billing NPI number supplied in Form Locator 56 as the Payee NPI in the 835.

 

Electronic Payments

The Proprietary Provider ID will no longer be used to consolidate electronic payments. Providers that receive payments electronically will receive consolidated payments by the Pay To or Billing NPI and TIN as noted above.

Paper Check Payments

Providers that receive paper check payments will receive consolidated payments by the Pay-To NPI, TIN, and Proprietary Provider ID if the Pay-To NPI is submitted on a claim. If a Pay-To NPI is not submitted on a claim, paper check payments will be consolidated by the Billing NPI, TIN, and Proprietary Provider ID.


INDUSTRY NEWS TAGS: United Healthcare


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